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Five takeaways from the court decision striking down ObamaCare

A federal judge in Texas cast new uncertainty on the fate of ObamaCare when he issued a ruling striking down the entire Affordable Care Act (ACA).

U.S. District Court Judge Reed O'Connor's decision Friday sent shockwaves through the country and health-care industry after he ruled in favor of a challenge from 20 GOP-led states and struck down the law.

As the political world scrambles to figure out the implications, here are five takeaways from the decision:

ObamaCare is still in effect and people can still sign up

Despite the high-profile ruling, nothing has changed in the short term involving coverage under the law.

The Affordable Care Act is still in effect and providing people with health insurance. In fact, the deadline to sign up for coverage next year is early Sunday morning, at 3 a.m., so there are still a few hours to sign up.

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The ruling will not go into effect until there are appeals to higher courts, where many expect it to be reversed. But there is the risk of confusion from all of the headlines about the law being struck down.

Some supporters of the law have accused the judge, a conservative appointee of former President George W. Bush, of purposefully ruling the night before the deadline in an effort to depress enrollment.

“Although this ruling is not in effect, will be appealed, and will likely be reversed, it is causing mass harm,” Topher Spiro, vice president for health policy at the liberal Center for American Progress, wrote on Twitter. “Many will be deterred from enrolling. Many will suffer anxiety and fear.”

Abbe Gluck, a Yale law professor and supporter of the ACA, wrote a joint opinion piece in The New York Times on Saturday with Jonathan Adler, a Case Western Reserve law professor and opponent of the health law.

“We agree that this decision makes a mockery of the rule of law and basic principles of democracy,” they wrote.

O’Connor ruled that because in 2012 the Supreme Court upheld the law’s mandate to have coverage under the power to tax, once Congress repealed the penalty for failing to comply with the mandate last year, the mandate is no longer a tax and therefore is unconstitutional.

But where legal experts particularly criticize O’Connor is his next step, where he ruled that because the mandate is unconstitutional, the rest of the Affordable Care Act is also invalid.

Experts say that violates the established legal standard that Congress’s intent should be the guide, and in this case it is obvious that Congress intended for the rest of the Affordable Care Act to remain when it repealed only the mandate penalty last year.

The ruling is expected to be appealed

Given the sharp criticisms of the judge’s reasoning from both the left and the right, experts expect that the decision will be reversed on appeal and that the Affordable Care Act will be upheld.

Tim Jost, a health law expert at Washington and Lee University, said he is “really certain” that the Supreme Court would not rule for the challengers to the ACA, and that the challenge would get the votes of maybe just three of the nine justices.

Nicholas Bagley, a law professor at the University of Michigan, said he thinks the case is likely not to even make it to the Supreme Court, since the 5th Circuit Court of Appeals could reverse O’Connor’s decision itself.

Still, if the Supreme Court did end up ruling to overturn the law, it would cause chaos. Health insurance for roughly 20 million people would be put in jeopardy and ripple effects would spread into Medicare, Medicaid, and employer-sponsored insurance, with unpredictable results.

Democrats plan to go on the attack

House Democrats plan to move quickly once they take control in January to have the House formally intervene in the lawsuit and argue in defense of the ACA.

And they are showing no interest in Republicans’ calls to start over and work on a bipartisan replacement to the law — a task that is practically all but impossible. Democrats want to defend the law that already exists and attack Republicans for undermining it.

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“I think it’s more the House swiftly intervenes in the Texas lawsuit, and then goes after the full spectrum of the ways the GOP has tried to sabotage health care and the ACA,” said a House Democratic aide. “Oversight is a part of that too.”

Republicans face a quandary in how to respond to the ruling

As last year's collapse in the Senate of efforts to repeal and replace ObamaCare showed, Republicans have great difficulty in agreeing on any proposal to replace the Affordable Care Act.